Advertisement

Mood Stabilizers in Pregnancy

  • Anne-Laure Sutter-DallayEmail author
  • Florence Gressier
Chapter

Abstract

The increased risk of onset or recurrence of bipolar disorders during the perinatal period raises the crucial question of management of mood stabilizers. Women and their partners have to be informed and helped to be able to give an informed consent for the choice that they make. For clinicians, the prescription of mood stabilizers, as that of any psychotropic drug during pregnancy, is challenging, and they have to be able to weigh the risk of a maternal relapse vs. the risk of antenatal exposure to the drug, that is, should treatment be interrupted or modified against the teratogenic or fetotoxic risk of antenatal exposure to the drug.

Keywords

Pregnancy In utero exposure Mood stabilizers Foetus Infant development 

References

  1. 1.
    Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ. Episodes of mood disorders in 2252 pregnancies and postpartum periods. Am J Psychiatry. 2011;168:1179–85.CrossRefGoogle Scholar
  2. 2.
    Van der Lugt NM, Van de Maat JS, Van Kamp IL, Knoppert-van der Klein EA, Hovens JG, Walther FJ. Fetal, neonatal and developmental outcomes of lithium-exposed pregnancies. Early Hum Dev. 2012;88:375–8.CrossRefGoogle Scholar
  3. 3.
    Jones I, Craddock N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry. 2005;186:453–4.CrossRefGoogle Scholar
  4. 4.
    Bodén R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ. 2012;345:e7085.CrossRefGoogle Scholar
  5. 5.
    Ernst CL, Goldberg JF. The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. J Clin Psychiatry. 2002;63(Suppl 4):42–55.PubMedGoogle Scholar
  6. 6.
    Clark CT, Klein AM, Perel JM, Helsel J, Wisner KL. Lamotrigine dosing for pregnant patients with bipolar disorder. Am J Psychiatry. 2013;170:1240–7.CrossRefGoogle Scholar
  7. 7.
    Gaffield ME, Culwell KR, Lee CR. The use of hormonal contraception among women taking anticonvulsant therapy. Contraception. 2011;83:16–29.CrossRefGoogle Scholar
  8. 8.
    Zhang L, Li H, Li S, Zou X. Reproductive and metabolic abnormalities in women taking valproate for bipolar disorder: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2016;202:26–31.CrossRefGoogle Scholar
  9. 9.
    Sutter-Dallay AL, Bales M, Pambrun E, Glangeaud-Freudenthal NM, Wisner KL, Verdoux H. Impact of prenatal exposure to psychotropic drugs on neonatal outcome in infants of mothers with serious psychiatric illnesses. J Clin Psychiatry. 2015;76:967–73.CrossRefGoogle Scholar
  10. 10.
    Newport DJ, Viguera AC, Beach AJ, Ritchie JC, Cohen LS, Stowe ZN. Lithium placental passage and obstetrical outcome: implications for clinical management during late pregnancy. Am J Psychiatry. 2005;162:2162–70.CrossRefGoogle Scholar
  11. 11.
    Giles JJ, Bannigan JG. Teratogenic and developmental effects of lithium. Curr Pharm Des. 2006;12:1531–41.CrossRefGoogle Scholar
  12. 12.
    Schou M, Goldfield MD, Weinstein MR, Villieneuve A. Lithium and pregnancy. I. Report from the Register of Lithium Babies. BMJ. 1973;2:135–6.CrossRefGoogle Scholar
  13. 13.
    Weinstein MR, Goldfield M. Cardiovascular malformations with lithium use during pregnancy. Am J Psychiatry. 1975;132:529–31.CrossRefGoogle Scholar
  14. 14.
    Kozma C. Neonatal toxicity and transient neurodevelopmental deficits following prenatal exposure to lithium: another clinical report and a review of the literature. Am J Med Genet A. 2005;132A(4):441–4.CrossRefGoogle Scholar
  15. 15.
    Nora JJ, Nora AH, Toews WH. Lithium, Ebstein’s anomaly, and other congenital heart defects. Lancet. 1974;2(7880):594–5.CrossRefGoogle Scholar
  16. 16.
    Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S. Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med. 2017;376(23):2245–54.CrossRefGoogle Scholar
  17. 17.
    Zalzstein E, Koren G, Einarson T, Freedom RM. A case-control study on the association between first trimester exposure to lithium and Ebstein’s anomaly. Am J Cardiol. 1990;65:817–8.CrossRefGoogle Scholar
  18. 18.
    Boyle B, Garne E, Loane M, Addor MC, Arriola L, Cavero-Carbonell C, Gatt M, Lelong N, Lynch C, Nelen V, Neville AJ, O’Mahony M, Pierini A, Rissmann A, Tucker D, Zymak-Zakutnia N, Dolk H. The changing epidemiology of Ebstein’s anomaly and its relationship with maternal mental health conditions: a European registry-based study. Cardiol Young. 2017;27:677–85.CrossRefGoogle Scholar
  19. 19.
    Jacobson SJ, Jones K, Johnson K, Ceolin L, Kaur P, Sahn D, Donnenfeld AE, Rieder M, Santelli R, Smythe J, et al. Prospective multicentre study of pregnancy outcome after lithium exposure during first trimester. Lancet. 1992;339(8792):530–3.CrossRefGoogle Scholar
  20. 20.
    Gentile S. Lithium in pregnancy: the need to treat, the duty to ensure safety. Expert Opin Drug Saf. 2012;11:425–37.CrossRefGoogle Scholar
  21. 21.
    Diav-Citrin O, Shechtman S, Tahover E. Pregnancy outcome following in utero exposure to lithium: a prospective, comparative, observational study. Am J Psychiatry. 2014;171:785–94.CrossRefGoogle Scholar
  22. 22.
    Mcknight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379:721–8.CrossRefGoogle Scholar
  23. 23.
    Bergink V, Kushner SA. Lithium during pregnancy. Am J Psychiatry. 2014;171:712–5.CrossRefGoogle Scholar
  24. 24.
    Iqbal MM, Sohhan T, Mahmud SZ. The effects of lithium, valproic acid, and carbamazepine during pregnancy and lactation. J Toxicol Clin Toxicol. 2001;39:381–92.CrossRefGoogle Scholar
  25. 25.
    Youngs RM, Chu MS, Meloni EG, Naydenov A, Carlezon WA Jr, Konradi C. Lithium administration to preadolescent rats causes long-lasting increases in anxiety-like behavior and has molecular consequences. J Neurosci. 2006;26:6031–9.CrossRefGoogle Scholar
  26. 26.
    Forsberg L, Adler M, Römer Ek I, Ljungdahl M, Naver L, Gustafsson LL, Berglund G, Chotigasation A, Hammar U, Böhm B, Wide K. Maternal mood disorders and lithium exposure in utero were not associated with poor cognitive development during childhood. Acta Paediatr. 2018;107:1379. https://doi.org/10.1111/apa.14152.CrossRefPubMedGoogle Scholar
  27. 27.
    Haskey C, Galbally M. Mood stabilizers in pregnancy and child developmental outcomes: a systematic review. Aust N Z J Psychiatry. 2017;51:1087–97.CrossRefGoogle Scholar
  28. 28.
    Wesseloo R, Wierdsma AI, van Kamp IL, Munk-Olsen T, Hoogandijk WJG, Kushner SA, Bergink V. Lithium dosing strategies during pregnancy and the postpartum period. Br J Psychiatry. 2017a;211:31–6.CrossRefGoogle Scholar
  29. 29.
    NICE. NICE guidelines. Antenatal and postnatal mental health: clinical management and service guidance [CG192]. London: NICE; 2014.Google Scholar
  30. 30.
    Viguera AC, Nonacs R, Cohen LS Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157:179–84.CrossRefGoogle Scholar
  31. 31.
    Viguera AC, Whitfield T, Baldessarini RJ Newport DJ, Stowe Z, Reminick A, Zurick A, Cohen LS. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164:1817–24.CrossRefGoogle Scholar
  32. 32.
    Burt VK, Rasgon N. Special considerations in treating bipolar disorder in women. Bipolar Disord. 2004;6:2–13.CrossRefGoogle Scholar
  33. 33.
    Bank AM, Stowe ZN, Newport DJ, Ritchie RJ, Pennell PB. Placental passage of antiepileptic drugs at delivery and neonatal outcomes. Epilepsia. 2017;58:e82–6.CrossRefGoogle Scholar
  34. 34.
    Galbally M, Snellen M, Walker S, Permezel M. Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. Aust N Z J Psychiatry. 2010;44:99–108.CrossRefGoogle Scholar
  35. 35.
    Campbell E, Kennedy F, Russell A. Malformation risks of antiepileptic drug monotherapies in pregnancy: updated results from the UK and Ireland Epilepsy and Pregnancy Register. J Neurol Neurosurg Psychiatry. 2014;85:1029–34.CrossRefGoogle Scholar
  36. 36.
    Veiby G, Daltveit AK, Engelsen BA, Gilhus NE. Fetal growth restriction and birth defects with newer and older antiepileptic drugs during pregnancy. J Neurol. 2014;261:579–88.CrossRefGoogle Scholar
  37. 37.
    Baker GA, Bromley RL, Briggs M, Cheyne CP, Cohen MJ, García-Fiñana M, Gummery A, Kneen R, Loring DW, Mawer G, Meador KJ, Shallcross R, Clayton-Smith J, Liverpool and Manchester Neurodevelopment Group. IQ at 6 years after in utero exposure to antiepileptic drugs: a controlled cohort study. Neurology. 2015;84:382–90.CrossRefGoogle Scholar
  38. 38.
    Van der Pol MC, Hadders-Algra M, Huisjes HJ, Touwen BC. Antiepileptic medication in pregnancy: late effects on the children’s central nervous system development. Am J Obstet Gynecol. 1991;164:121–8.CrossRefGoogle Scholar
  39. 39.
    Gedzelman E, Kimford J, Meador MD. Antiepileptic drugs in women with epilepsy during pregnancy. Ther Adv Drug Safe. 2012;3:71–87.CrossRefGoogle Scholar
  40. 40.
    Hernández-Díaz S, Smith CR, Shen A, Mittendorf R, Hauser WA, Yerby M, Holmes LB, North American AED Pregnancy Registry; North American AED Pregnancy Registry. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2012;78:1692–9.CrossRefGoogle Scholar
  41. 41.
    Eriksson K, Viinikainen K, Mönkkönen A, Aikiä M, Nieminen P, Heinonen S, Kälviäinen R. Children exposed to valproate in utero--population based evaluation of risks and confounding factors for long-term neurocognitive development. Epilepsy Res. 2005;65:189–200.CrossRefGoogle Scholar
  42. 42.
    Casassus B. France bans sodium valproate use in case of pregnancy. Lancet. 2017;390(10091):217.CrossRefGoogle Scholar
  43. 43.
    Arkilo D, Hanna J, Dickens D. Pregnancy and neurodevelopmental outcomes with in-utero antiepileptic agent exposure. A pilot study. Eur J Paediatr Neurol. 2015;19:37–40.CrossRefGoogle Scholar
  44. 44.
    Kong L, Zhou T, Wang B, Gao Z, Wang C. The risks associated with the use of lamotrigine during pregnancy. Int J Psychiatry Clin Pract. 2018;22:2–5.CrossRefGoogle Scholar
  45. 45.
    Wesseloo R, Liu X, Clark CT, Kushner SA, Munk-Olsen T, Bergink V. Risk of postpartum episodes in women with bipolar disorder after lamotrigine or lithium use during pregnancy: a population-based cohort study. J Affect Disord. 2017b;218:394–7.CrossRefGoogle Scholar
  46. 46.
    Alsaad AM, Chaudhry SA, Koren G. First trimester exposure to topiramate and the risk of oral clefts in the offspring: a systematic review and meta-analysis. Reprod Toxicol. 2015;20:45–50.CrossRefGoogle Scholar
  47. 47.
    Hernandez-Diaz S, Huybrechts KF, Desai RJ Cohen JM, Mogun H, Pennell PB, Bateman BT, Patorno E. Topiramate use early in pregnancy and the risk of oral clefts: a pregnancy cohort study. Neurology. 2018;90:e342–51.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Anne-Laure Sutter-Dallay
    • 1
    • 2
    • 3
    Email author
  • Florence Gressier
    • 4
    • 5
  1. 1.CH Charles PerrensBordeauxFrance
  2. 2.Bordeaux Population Health Research Center, INSERM 1219Bordeaux UniversityBordeauxFrance
  3. 3.Pharmaco-Epidemiology and Population Health TeamBordeaux UniversityBordeauxFrance
  4. 4.CESP, INSERM, UMR1178Univ Paris SudLe Kremlin BicêtreFrance
  5. 5.Department of Psychiatry, Bicêtre University HospitalUniv Paris SudLe Kremlin BicêtreFrance

Personalised recommendations